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Review

Exercise as Medicine: Tackling Chronic Pain and Depression to Boost Quality of Life—A Narrative Review

by
William J. Hanney V
1,
Abigail W. Anderson
1,
Morey J. Kolber
2,
Violette Gibbs
1 and
William J. Hanney IV
1,*
1
School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, FL 32816, USA
2
Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
*
Author to whom correspondence should be addressed.
Sci 2025, 7(1), 10; https://doi.org/10.3390/sci7010010
Submission received: 11 November 2024 / Revised: 3 January 2025 / Accepted: 9 January 2025 / Published: 15 January 2025
(This article belongs to the Section Biology Research and Life Sciences)
Browse Figure
Versions Notes

Abstract

:
Depression and chronic pain are prevalent and often co-occurring conditions that pose substantial treatment challenges and economic burdens in the developed world. Research suggests that depression and chronic pain share overlapping pathways, particularly within the anterior cingulate cortex, which plays a critical role in emotional regulation and pain perception. Research indicates that exercise may alleviate depression. Given the shared neurobiology between depression and chronic pain, it is plausible that exercise could improve outcomes for individuals experiencing depression and chronic pain. Therefore, this review aims to provide clinicians with evidence-based tools to assess the role of exercise in the management of patients with coexistent pain and depression.

1. Introduction

Depression and pain are common conditions that frequently co-occur [1]. Depression alone represents a substantial economic burden for adults with estimated costs of USD 210.5 billion in 2010 [2]. Additionally, up to 60% of patients with chronic pain also experience depression, highlighting this comorbid dual diagnosis [3,4,5]. Chronic pain itself costed USD 560–635 billion in 2010 in terms of healthcare expenses, which is more than the combined expenses of cancer, diabetes, and heart disease [6,7].
Depression and chronic pain also share similar neurological pathways, as both conditions have been shown to impact the anterior cingulate cortex (ACC), a part of the brain responsible for emotional regulation, and pain perception [8,9,10]. Several hypotheses suggest that exercise can alleviate the symptoms of depression, and due to the shared pathways, it is plausible that exercise may also improve quality of life in patients with comorbid depression and chronic pain [8,9,10].
Despite research suggesting that exercise may benefit both patients with depression and chronic pain as independent diagnoses, limited research has exclusively studied how exercise may benefit patients with both conditions. Therefore, this study aims to provide clinicians with evidence-based tools on how exercise could potentially assist with the treatment and prevention of coexistent pain and depression.

2. Depression: Definition, Etiology, and Symptoms

Depression is one of the most common and debilitating public health concerns and a leading cause of disability impacting a wide variety of people globally [11]. Major Depressive Disorder (MDD), characterized by severe depressive episodes lasting more than two weeks, has a lifetime prevalence of 9.1%, while Persistent Depressive Disorder (PDD), a less severe but longer-lasting form of depression, has a lifetime prevalence of 15.2% [12,13,14]. Many other forms of depression exist (such as seasonal affective disorder), although MDD and PDD are generally the most common [15]. Chronic pain, which affects approximately 20.5% of individuals, frequently coexists with depression oftentimes exacerbated by one another [6,16,17,18].
If depression is severe and left unmanaged, then it can increase the risk of suicide, yet the interpretation of depression’s causes across studies is difficult, due to the fragmentation of the etiology of depression [19]. Arguably, the most widespread and influential theory about depression’s etiology is the serotonin hypothesis of depression, where a lack of serotonin is the causation of depression, and this hypothesis has been generally considered to be inadequate [20,21,22]. With this being stated, SSRI’s (Selective Serotonin Reuptake Inhibitors) and other drugs that impact serotonin reuptake are still used as a first-line treatment for depression [23]. According to Remes et al. [19], the cross-pollination of various ideas between disciplines such as neurology, immunology, psychology, and genetics is quite limited [19]. Oftentimes when reviews are performed on the etiology of depression, the focus is on one specific factor that may cause depression (i.e., social or environmental issues) [19]. A more multifaceted approach to a review on depression may be deeply beneficial in determining how it may relate to, cause, or interfere with chronic pain [19].
Psychotherapy is a common way to treat depression; however, evidence suggests a success rate of approximately 33% [24]. It is important to note that many types of psychotherapies exist with various success rates across different types of depression [25]. A meta-analysis by Kolovos et al. [24] stated that 27% of people who underwent psychotherapy had a 50% reduction in depressive symptoms; however, heterogeneity was quoted as being substantial in most analysis and not fully explained by subgroup analysis. Therefore, the quality of studies in this meta-analysis was deemed “moderate”, which may lead to the overestimation of the true effects. A separate systematic review and meta-analysis by Cujipers et al. [26] stated that only 60% of youth receiving psychotherapy responded to it [26]. However, a study by Cladder-Micus et al. [27] suggested that a variation in psychotherapy named “mindfulness-based cognitive behavioral therapy” may be more effective than other standard approaches to psychotherapy. Overall, this shows that depressive disorders may be a pervasive problem that is difficult to treat; yet exercise may be an inexpensive and practical way to treat and prevent both depression and chronic pain with minimal risk [28,29,30,31].

3. Chronic Pain: Definition, Etiology, and Symptoms

Chronic pain may be defined by the duration of symptoms, typically pain that lasts over 3–6 months [6,32]. Additionally, chronic pain is commonly associated with a decrease in quality of life and contributes to significant medical costs [18]. A study from Yong et al. [18] stated that 50.2 million adults, or 20.5% of people in the US, reported pain most days or every day [18]. Chronic pain impacts a similar amount of people in Europe as the US, with about 20% of the European population having chronic pain [33]. Most people who experience chronic pain are older with comorbid health issues [28,29,30].
Chronic pain encompasses various types of pain, each with its own unique etiology [6], which can complicate the clinical presentation [6,34]. While chronic pain arises from a variety of underlying causes, there are distinct presentations [6,35]. As stated by Treede et al. [36], pain can be categorized into seven types. Each type of pain can exist independently or in conjunction with another (Table 1).

4. Depression and Its Relationship to Chronic Pain

Depression is related to chronic pain, and evidence suggests that they share the same neurotransmitters and biological pathways [1]. A study by Blier et al. [37] reported that antidepressants may help treat chronic pain, possibly by blocking 5-HT2A receptors (a receptor for serotonin) in the body. Since pain and depression share similar neurophysiologic pathways, antidepressants that affect serotonin transmission have shown potential in relieving chronic pain as well [37,38]. For this reason, treatments that can impact serotonin levels (such as exercise; Table 2) may be beneficial for the treatment of chronic pain [39].
Chronic pain and depression have also been shown to modulate serotonin, increase immune modulation, and impact melatonin production; all of which may impact quality of life [37,38,40]. Physical symptoms are common in patients with depression; unexplainable aches and pains are oftentimes a sign of a depressive episode [40]. Pain experienced during a depressive episode often includes changes in appetite, alterations in psychomotor activity, fatigue, sleep disturbances, gastrointestinal issues, and back pain [40]. Comorbid depression and pain are also common in geriatric patients; research from Zis et al. [41] suggests that 13% of the elderly population suffers from comorbid conditions at any given time [41]. Authors have reported that 67% of people with chronic pain share a comorbid psychological disorder such as anxiety or depression [6,16,17].
Depression and pain are commonly presented together, with the comorbid pathology being referred to as “depression–pain syndrome” or “depression–pain dyad”. This terminology implies that the separate conditions may be caused or exacerbated by one condition or the other [1,37,42,43]. Exercise may be beneficial as a single treatment for comorbid pain and depression since it has been shown to be an effective treatment for each condition independently [31,44,45,46,47,48,49].

5. Neurological Similarities Between Comorbid Depression and Pain

Chronic pain and depression are linked through overlapping neurological pathways, which may impact potential treatment options for these comorbid conditions. A common hub for pain is the anterior cingulate cortex (ACC) and insula, which are responsible for the processing of both pain and depression [8,50]. Other subcortical structures such as the amygdala and central tegmental area are involved in emotional and contextual portions of the perception of pain [50]. These same regions of the brain are also responsible for feelings of depression, which may explain why many people experiencing depression also experience pain that is not easily explainable [38,50]. As suggested by Han et al. [38], alterations in pro-inflammatory cytokines [51] and their gene expression [52], as well as changes in melatonin [53], disturbance in neurotransmitters (such as serotonin and norepinephrine) [54,55], stress susception [56], childhood abuse [56], and alterations in the hypothalamus–pituitary–adrenal axis function [57] are all known to play a role in the manifestation of both pain and depression. Additionally, chronic pain includes a number of neurotransmitters that are also associated with depression, such as GABA, glutamate, norepinephrine, serotonin, neurokinin 1, nitric oxide, substance P, glycine, and opioids. The overlaps between these neurotransmitters in the presentation of chronic pain and depression are complex and involve multiple physiologic mechanisms.
The phasic dopamine system within the ventral tegmental area (VTA) and substantia niagra (SN) projects to the ventral striatum. The dopaminergic neurons within this system are responsible for feelings of reward, although studies have suggested that this system is biologically interrupted in people with chronic pain [58]. In animal studies, chronic pain led to decreased dopamine levels and striatal D2 receptors [58,59,60]. Dopamine signaling plays a crucial role in motivating approach or avoidance behaviors in response to a salient stimulus, rather than reflecting its hedonic value [58,61,62]. Consequently, chronic pain leads to behaviors consistent with a hypodopaminergic state [58,61,62]. However, when food rewards are readily accessible (e.g., under a fixed-ratio operant task), there is no difference in reward consumption between individuals with chronic pain and control groups [58,61,62]. However, there are many possible overlapping mechanisms between the two conditions (Table 2), and exercise may alleviate comorbid depression and pain.
Table 2. Proposed theories for the mechanism of the depression–exercise relationship.
Table 2. Proposed theories for the mechanism of the depression–exercise relationship.
Hypothesis of Function Method of Action
Thermogenic Hypothesis The Thermogenic Hypothesis suggests that a rise in core body temperature following the performance of exercise is responsible for the reduction in depressive symptoms [63]. De Vries suggests that an increase in temperature of specific regions in the brain after exercise may increase feelings of relaxation in muscular tension [63,64].
Endorphin Hypothesis The Endorphin Hypothesis suggests that exercise has a positive effect on depression due to an increased release of β-endorphins following the performance of exercise [63]. Endorphin release is often associated with a boost in positive mood [63].
Monoamine Hypothesis This hypothesis suggests that exercise can lead to an increased number of available neurotransmitters that may be responsible for positive emotions (serotonin, dopamine, norepinephrine, etc.) and are thought to be diminished in depressed patients [63].
Distraction Hypothesis The Distraction Hypothesis suggests that exercise may serve as a way to distract a depressed patient from depressing thoughts [63,65].
Self-Efficacy Hypothesis The Self-Efficacy Hypothesis suggests that a depressed patient’s self-efficacy may be increased after the performance of exercise. Bandura once described how depressed individuals may lack self-efficacy, which may lead to negative thoughts and rumination [63,64,66,67,68].

6. Effects of Exercise on the Prevention and Treatment of Comorbid Depression and Chronic Pain

Exercise may be an underutilized treatment for chronic pain and depression. The World Health Organization (WHO) reports that, globally, 31% of adults in 2024 did not meet the recommended levels of exercise in 2022 [48]. A lack of regular physical exercise may increase the risk of developing comorbid depression and chronic pain [47,49]. Encouraging greater levels of exercise could be a valuable approach for mitigating these risks.
Exercise can be divided into two different categories: aerobic and anerobic. The American College of Sports Medicine (ACSM) defines aerobic exercise as any activity that uses large muscle groups, is rhythmic in nature, and can be maintained continuously [69,70]. Furthermore, ACSM defines anerobic exercise as intense exercise that is very short in duration, fueled by energy sources within contracting muscles, and is independent of inhaled oxygen as a consistent source of energy [69,71]. Examples of aerobic exercise could be running or cycling, and examples of anerobic exercise could be barbel squatting or bench pressing. Each of these forms of exercise provides various types of benefit to the person performing them.
Exercise is one of the main predictive factors of a healthy life [45,72]. There is evidence that exercise reduces many types of diseases, such as cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, and osteoporosis (this study predominantly viewed exercise’s effects in middle-aged women) [45]. Exercise has been shown to have incremental effects (i.e., those who exercise the most have the most health benefits) [45,46,47]. A study by Blair et al. [73] suggested that subjects who went from unfit to fit over the course of a five-year period had a 44% reduction in the relative risk of death compared to those who were unfit. Various types of activities show various types of benefit, for example, anaerobic exercise has been shown to reduce high blood pressure and type 2 diabetes, improve lipid profile, and reduce the risk of cardiovascular disease [74,75,76,77]. Resistance training has been shown to lead to the development of healthy bone mass and muscular fitness [74,78].
Exercise has been shown to have many general health benefits [45,46,47]. Even exercising below the limit recommended by public health is correlated with improvement [48]. Exercise may be a cost-effective, beneficial, and overlooked methodology to reduce comorbid chronic pain and depression. Both anerobic and aerobic exercise have their own unique benefits for the treatment of comorbid depression and pain.

6.1. Anerobic Exercise

Anaerobic exercise involves short, intense bursts of activity that rely on energy stored in the muscles, rather than oxygen, to fuel the body [69,71]. However, the impact of anerobic training on depression has not been studied to the same degree as aerobic exercise [79]. A meta-analysis from Carneiro et al. [80] suggests that the primary outcomes of resistance training, a form of anerobic training, as a treatment for depression did not improve significantly across intervention groups, although authors noted poor adherence to the training protocols may have impacted the results of the research [80]. Moreover, a study by Augustin et al. [79] was published three years after the meta-analysis from Carneiro et al. [80] and suggested resistance training may be a viable treatment for depression [79]. While the literature may have conflicting reports, some authors have suggested that resistance training-based supervised programs may be beneficial in the treatment of depression [80]. However, more research must be conducted to determine if this is a viable treatment option [80,81]. Generally, resistance training has demonstrated some positive effects for those suffering from depression and chronic pain particularly as it has the ability to improve quality of life [82,83].

6.2. Aerobic Exercise

Aerobic exercise is defined by the ACSM as any type of activity that utilizes large muscle groups, is rhythmic in nature, and can be maintained continuously [69,70]. Research suggests that aerobic exercise is particularly beneficial for the treatment and prevention of depressive disorders [48]. A randomized controlled trial from Verhoven et al. [49] demonstrated that aerobic exercise was effective as an antidepressant, although some types of aerobic exercise, specifically running, may be the most beneficial form of aerobic exercise for relieving depressive symptoms [49]. The limitations of the Verhoven et al. [49] study include that only 15% of the subjects were randomized, which is considered a partially randomized patient preference design. Aerobic exercise also had the benefit of improving patients’ physical health, as well as their depression [49]. Aerobic exercise has also been shown to reduce pain intensity and functional disability in patients with chronic lower back pain, especially when used in conjunction with other measures such as education and physiotherapy [49]. This form of treatment has been shown to improve patients’ aerobic capacity and endurance, as well as other forms of chronic pain, which, in turn, improved their quality of life [84]. Aerobic exercise may be a low-risk and cost-effective form of treatment for depression and chronic pain, which does not make a patient’s physical condition worse [85,86,87,88].

7. Practical Ways by Which Exercise Could Improve the Outcome of Comorbid Depression/Pain

Research on managing comorbid depression and chronic pain exercise remains limited. However, aerobic exercise has long been established as an effective treatment for depression [79,80,81]. A study by Pearce et al. [48] indicates that even engaging in exercise below the recommended levels can provide substantial benefits for treating depression. For those experiencing depression, incorporating aerobic exercise consistently, at a minimum of 15 min daily and reaching 60–75% of their maximum heart rate, may be particularly beneficial [19,51,81,89,90].
Consistently performing aerobic exercise, a minimum of 15 min daily up to 60–75% of the individual’s maximal heart rate, may be beneficial to those experiencing depression [71,87,89,90,91]. Additionally, resistance exercise targeting various parts of the body may reduce pain [82,92], and a mix of weightlifting and aerobic exercise may be beneficial for the treatment of comorbid depression and pain [49,79,80]. Emphasis should be placed on the fact that resistance training offers a significant variety in the context of structuring exercise routines; therefore, training should be planned with and carried out with qualified strength and conditioning professionals [79]. Table 3 explains some of the following hypotheses as to why exercise can help people recover from depression, although some of these theories have encountered some criticisms [63]. Figure 1 illustrates how exercise may be applied to support patients for managing comorbid chronic pain and depression as well as for improving outcomes [63,64,66,67,68].
It may be important for clinicians to consider adding exercise to their treatment plans for patients with comorbid pain and depression [49,79,80]. The exercises shown in Table 3 and Table 4 may serve as a beneficial example of how exercise can be incorporated with treatments. The hypothetical patient explained in this chart has moderate chronic pain, moderate depression scores, and is roughly middle-aged. This type of treatment plan may need to be adapted to address other patient populations (pediatric, geriatric, bariatric, etc.).

8. Conclusions

A wide range of research indicates that exercise, when applied in real-world settings, may benefit patients with both depression and chronic pain. Exercise programs tailored by qualified strength and conditioning professionals can be adapted to each patient’s individual needs, and depressive symptoms can be possibly treated effectively with aerobic exercise, especially when exercise is used in conjunction with other common methods of treatment. Exercise may also enhance quality of life and positively influence pain perception. While studies support the benefits of exercise for each condition independently, limited research specifically addresses the most effective exercise types for coexisting depression and pain. This review aims to bridge those gaps in the literature. Overall, exercise represents a potentially underutilized and cost-effective intervention deserving of further investigation as a means of relieving comorbid depression and chronic pain.

Author Contributions

Conceptualization, W.J.H.V, A.W.A., M.J.K., V.G. and W.J.H.IV; methodology, W.J.H.V, A.W.A., M.J.K. and W.J.H.IV; resources, W.J.H.IV; writing—original draft preparation, W.J.H.V and W.J.H.IV; writing—review and editing, W.J.H.V, A.W.A., M.J.K., V.G. and W.J.H.IV. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Patient utilization of tools to combat comorbid chronic pain and depression.
Figure 1. Patient utilization of tools to combat comorbid chronic pain and depression.
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Table 1. The types of pain as stated by the International Association for the Study of Pain.
Table 1. The types of pain as stated by the International Association for the Study of Pain.
Name of PainDefinition of Pain
Chronic primary painChronic primary pain is defined as pain in one or more body regions that lasts or recurs for over three months and is linked to severe emotional distress or substantial disruption to daily activities and social role participation. This type of pain cannot be more accurately explained by another chronic pain disorder. This definition was developed to address situations where the cause of chronic pain remains unidentified.
This category includes common conditions such as back pain that does not fall under musculoskeletal or neuropathic categories, chronic widespread pain, fibromyalgia, and irritable bowel syndrome, whether there are biological findings that contribute to the pain. The term “primary pain” was chosen in coordination with the ICD-11 (International Classification of Diseases, 11th edition) revision team, as they believed it to be the most suitable term, especially for non-specialist clinicians.
Chronic cancer pain Chronic cancer pain, now recognized as a separate category in the ICD, is a common and debilitating aspect of cancer. It includes pain from the cancer itself (primary tumor or metastases) and pain resulting from cancer treatments (surgery, chemotherapy, radiotherapy, etc.). This type of pain is classified by location—visceral, bony/musculoskeletal, or somatosensory/neuropathic—and described as continuous (background pain) or intermittent (episodic pain). Treatment-related pain is cross-referenced with sections on postsurgical and neuropathic pain.
Chronic postsurgical and post-traumatic painChronic postsurgical and post-traumatic pain refers to pain that develops following surgery or tissue injury (such as trauma or burns) and lasts for at least three months beyond the normal healing period. It is a diagnosis of exclusion, meaning other causes of pain (e.g., infection or recurrent malignancy) and pre-existing pain conditions must be ruled out. For clarity and medicolegal reasons, postsurgical pain is distinguished from pain following other types of traumas. Chronic postsurgical pain frequently includes a neuropathic component that is present in about 30% of cases (ranging from 6% to over 54%), which tends to be more severe and negatively impacts quality of life more than nociceptive pain.
Chronic neuropathic pain Chronic neuropathic pain results from damage or disease affecting the somatosensory nervous system, which transmits sensory information about the body, including the skin, muscles, and internal organs. This pain can be spontaneous or triggered by a normally non-painful stimulus (allodynia) or an exaggerated response to pain (hyperalgesia). To diagnose neuropathic pain, there must be a history of nervous system injury (e.g., stroke, nerve trauma, or diabetic neuropathy) and a pain distribution that matches the affected area. Confirming the diagnosis requires evidence of the lesion or disease, such as through imaging or lab tests, and sensory signs consistent with the affected nerve area. Neuropathic pain is categorized into peripheral or central types, based on the origin of the lesion.
Chronic headache and orofacial pain Chronic headache and orofacial pain are defined as headaches or orofacial pains occurring on at least 50% of the days for a minimum of three months. The International Headache Society (IHS) classifies headaches into primary (idiopathic) and secondary (symptomatic), along with orofacial pain conditions like cranial neuralgias.
Common chronic headaches include migraines, while the most frequent chronic orofacial pain is temporomandibular disorders. Chronic orofacial pain can also result from primary headaches, especially in trigeminal autonomic cephalalgias, and is less common in migraines or tension-type headaches. Some orofacial pains, like post-traumatic trigeminal neuropathic pain and burning mouth syndrome, are cross-referenced with primary chronic pain and neuropathic pain categories. The definition of “chronic” is based on the criteria for chronic headaches.
Chronic visceral pain Chronic visceral pain is ongoing or recurring pain originating from the internal organs of the head, neck, thoracic, abdominal, and pelvic regions. This pain is often felt in somatic areas of the body, such as the skin, muscles, or subcutaneous tissue, which share sensory nerve pathways with the affected organ (referred visceral pain). Secondary hyperalgesia, where pain sensitivity increases in areas distant from the original source, is common. The severity of visceral pain may not always correlate with the extent of internal damage or the stimulus. The section on visceral pain is divided into categories based on underlying causes: persistent inflammation, vascular issues (like ischemia or thrombosis), obstruction or distension, traction and compression, combined causes (e.g., obstruction and inflammation), and pain referred from other areas. Cancer-related pain is cross-referenced with chronic cancer pain, and pain from unexplained or functional causes is cross-referenced with chronic primary pain.
Chronic musculoskeletal pain Chronic musculoskeletal pain refers to persistent or recurrent pain resulting from diseases that directly affect the bones, joints, muscles, or related soft tissues. This category is limited to nociceptive pain, excluding conditions where pain is perceived in musculoskeletal tissues but originates elsewhere, such as compression neuropathy or somatic referred pain. It includes conditions characterized by persistent inflammation from infectious, autoimmune, or metabolic causes (e.g., rheumatoid arthritis) and structural changes in bones, joints, tendons, or muscles (e.g., symptomatic osteoarthritis). Neuropathic musculoskeletal pain is cross-referenced with neuropathic pain, while conditions like nonspecific back pain or chronic widespread pain, whose causes are not fully understood, are categorized under chronic primary pain.
Table 3. How different types of pain can be treated with exercise.
Table 3. How different types of pain can be treated with exercise.
Types of Pain Possible Treatment Modalities
Neuropathic pain Muscle stretching, muscle strengthening, resistance exercise, aerobic exercise, motor control/stabilization, and mind body exercises (such as Tai Chi and yoga) [93]. Performing a combination of these activities for 30–60 min a day for 10–12 weeks may be beneficial by decreasing pain and depression [94]. Aerobics, aquatic aerobics, and resistance training may be especially beneficial treatments for pain in patients with multiple sclerosis [93].
Musculoskeletal pain Aerobic and anerobic exercise has been shown to be beneficial for musculoskeletal pain and depression [31,49]. Performing strength exercises with high intensity (70–85% of RM) 3 times a week for 20 min may be beneficial [44].
Nociplastic painCommon treatment methods include cognitive behavioral therapy, and psychotherapy [13]. Consistent exercise and sleeping may help [95,96].
Table 4. Example of a treatment plan for chronic pain and depression.
Table 4. Example of a treatment plan for chronic pain and depression.
Level of Progress Potential Exercises a Patient Could Perform
Chronic musculoskeletal lower back pain and depressionBriefly walking daily for 20 min and reaching about 60% of the MHR [31,44,45,46,47].
Two weeks after performing initial exercise routine Walking daily for about 30 min and reaching 70% of the MHR, while also performing squats [31,44,45,46,47,82,92].
Four weeks after performing the initial exercise routineRunning and reaching about 75% of the MHR, while also consistently performing barbell squats [31,44,45,46,47,82,92].
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Hanney, W.J., V; Anderson, A.W.; Kolber, M.J.; Gibbs, V.; Hanney, W.J., IV. Exercise as Medicine: Tackling Chronic Pain and Depression to Boost Quality of Life—A Narrative Review. Sci 2025, 7, 10. https://doi.org/10.3390/sci7010010

AMA Style

Hanney WJ V, Anderson AW, Kolber MJ, Gibbs V, Hanney WJ IV. Exercise as Medicine: Tackling Chronic Pain and Depression to Boost Quality of Life—A Narrative Review. Sci. 2025; 7(1):10. https://doi.org/10.3390/sci7010010

Chicago/Turabian Style

Hanney, William J., V, Abigail W. Anderson, Morey J. Kolber, Violette Gibbs, and William J. Hanney, IV. 2025. "Exercise as Medicine: Tackling Chronic Pain and Depression to Boost Quality of Life—A Narrative Review" Sci 7, no. 1: 10. https://doi.org/10.3390/sci7010010

APA Style

Hanney, W. J., V, Anderson, A. W., Kolber, M. J., Gibbs, V., & Hanney, W. J., IV. (2025). Exercise as Medicine: Tackling Chronic Pain and Depression to Boost Quality of Life—A Narrative Review. Sci, 7(1), 10. https://doi.org/10.3390/sci7010010

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